0xrkylenzat.typeform.com
Open in
urlscan Pro
104.18.27.71
Public Scan
URL:
https://0xrkylenzat.typeform.com/to/M0oXnkNa
Submission: On March 30 via manual from DE — Scanned from DE
Submission: On March 30 via manual from DE — Scanned from DE
Form analysis 0 forms found in the DOM
Text Content
Spinner Question 1 1 Which of the following is true for you? (Please choose ONE) (A) I am fully vaccinated by the Moderna, Pfizer, or Johnson and Johnson vaccine (fully vaccinated means you have received 2 doses of the Moderna or Pfizer vaccine or 1 dose of the Johnson and Johnson vaccine) (B) I received a COVID-19 vaccine that was not the Moderna, Pfizer, or Johnson & Johnson vaccines (example: Astra Zeneca) (C) I have not received a COVID-19 vaccine KeyA choice 1 KeyB choice 2 KeyC choice 3 Submit press Enter ↵ Question 2 2 Employee Covid-19 Report Form Follow this step to answer and submit acknowledgment form * Employee Email: [Enter Organization email only] Submit press Enter ↵ Submit